Surgical tool

ABSTRACT

The probe of a hand held surgical tool includes a surgical tip at the end of a rod which swings through a limited arc in one plane only at a rate of less than about 100 cycles per second. One or more stationary tubes supply fluid to and/or suction fluid from the region of the tip. For eye surgery, the probe may use a globular tip about 1 millimeter in diameter having a small (0.1 mm) lateral or forward cutting projection and/or an abrasive surface. The tool facilitates cataract removal through a small limbal opening, and is useful for other surgical procedures of the eye and other body areas.

[451 May 7,1974

[ SURGICAL TOOL [76] Inventor: Samuel V. Abraham, 16026 Royal Oak Rd.,Encino, Calif. 91316 [22] Filed: Apr. 14, 1972 [21] App]. No.: 244,143

[52] U.S. Cl. 128/305 [51] Int. Cl. A6lb 17/32, A61f 9/00 [58] Field ofSearch 128/24 A, 41, 48, 276, 128/303' R, 304, 305

[5 6] References Cited UNITED STATES PATENTS 1,658,278 2/1928 Bardachet'al 128/41 UX 2,514,665 7/1950 Myller 128/304 X 2,874,470 2/1959Richards... 128/24 A X 2,990,616 7/1961 Balamuth et a] 32/26 3,076,9042/1963 Kleesattel et al. 128/24 A X FOREIGN PATENTS OR APPLICATIONS.

97,760 9/1924 Austria 128/41 Primary Examiner-Channing L. Pace Attorney,Agent, or Firm-Flam & Flam 57 ABSTRACT The probe of a hand held surgicaltool includes a surgical tip at the end of a rod which swings through alimited arc in one plane only at a rate of less than about 100 cyclesper second. One or more stationary tubes supply fluid to and/or suctionfluid from the region of the tip. For eye surgery, the probe may use aglobular tip about 1 millimeter in diameter having a small (0.1 mm)lateral orforward cutting projection and/or an abrasive surface. Thetool facilitates cataract removal through a small limbal opening, and isuseful for other surgical procedures of the eye and other body areas.

18 Claims, 14 Drawing Figures POW! QUPPLY 57 2 l 6 7 g 2 57 56 e 27 F363 a5 was a? J i "I 5/ /8 "/A4 I. I 56 57 PUMP 52 4/ PATENTEUHAY. mm38091093 sum 1 OF 2 v Powzn SUPPLY FLUID SUPPLY SURGICAL TOOL BACKGROUNDOF THE INVENTION 1. Field of the Invention The present invention relatesto a surgical tool having a globular cutting and/or abrasive tip at theend of a rod driven through a limited arc in a single plane.

2. Description of the Prior Art r Cataract surgery is necessitated whenthe lens of an eye becomes so occluded or opaque as to prevent lightentering throughthe cornea to reach the retina. In conventionalintracapsu lar extraction, a semicircular 150 to 180) incision is madealong the limbus where the cornea joins the opaque sclera of the eye.The entire lens is removed intact through this opening. Alternatively,in extracapsular extraction, a knife and forceps inserted through thelarge opening are used to sever and remove the anterior lens capsule,the lens material itself, and possibly the posterior capsule. Theincision is closed with multiple sutures.

Although a high success rate is associated with such cataract removalprocedures, certain complications are not uncommon. Considerabletraumais experienced, and a hospital stay of ,4 or more daysfollowingthe. operation is typical. The relatively large knife and forceps maycreate some difficulty. in completely removing all minute lensparticles. Fluid loss through the opening may be so great as to causecollapse of the cornea or a flat anterior chamber.

Certain improvements in surgical procedures and tools have beensuggested. Two-way syringe-like devices are known wherein eye fluid,possibly containing particles of lens material, is removed through onetube while a sterile isotonic fluid is supplied through a second tube.This maintains the necessary pressure in the anterior aqueous chamber toprevent corneal collapse. Amanual tool has been suggested in which suchtubes are concentric, the inner tube containing a knife blade rotatedwithin the outer tube to cut lens material extruded or suctionedinto thetubes through lateral opening s. Such a device, while effective for theremoval of relatively soft lens material, is not useful forincising thelenscapsule, andmaybe ineffective in the removal of senile cataracts.

An ultrasonic emulsifier for cataract surgery is described in the US.Pat. No. 3,589,363 to Banko and Kelman. That instrument uses aknife-tipped probe reciprocated longitudinally at an ultrasonic rate,typically from 1,000 to 100,000cycles per second, to break up lensmaterial. Use of the emulsifier is described in Highlights ofOphthalmology, Volume XIII, No. 1 beginning at page 38. A small limbalincision first is made, and a cystotome, iris forceps and scissors areused to remove aV-shaped section of the anterior capsule; Theultrasonically vibrated knife probe is inserted throughthis opening intothe lens. The rapid reciprocation acts like a miniature jack hammer tobreak up and emulsify lenscortex and nucleus material, which issuctionedout by a tube surrounding the tip. A second tube supplies fluidto replace that removed and maintain the necessary chamber pressure.

An object of thepresent invention is to provide an improved cataractremoval tool requiring a single small openingto the eye, whichfacilitates the cutting and removal of both capsule and lens material,and which may be used without the traumatic effects associated 2 withprior art large opening and ultrasonic emulsificav tion techniques.Inaddition to cataract removal, the inventive tool is useful for othersurgical procedures both of the eye and of other body areas.

SUMMARY OF INVENTION The foregoing and other objectives are achieved byproviding a hand held surgical tool having a probe which is driven backand forth through a limited arc in a single plane at a selectable rateof between 0 and about cycles per second. For eye surgery, the probe maycomprise a rod having a diameter of O.5 millimeter and a globulartipabout l millimeter in diameter. The tip may include a lateral orforward cutting projection extending about 0.1 millimeter 'from theglobe, which itself may be smooth or abrasive. The probe may include oneor more tubes for communicating fluid to and/or suctioning fluid fromthe region of the tip. In other embodiments, the tool may include afreezing or heating tip, a fiber optic light guide, and/or a forcepstip. r

with reference to the accompanying drawings wherein like numeralsdesignate corresponding elements in the several figures. i r

FIG; 1 is a pictorial view of the inventive surgical tool with the probeoperatively positioned in the anterior aqueous chamber of an eye (shownin section).

FIG. 2 is a longitudinal sectional view of the surgical tool, as seenalongthe line 2 2 of FIG. 1.

FIG. 3 is a longitudinal sectional view of the same surgical tool in aplane perpendicular to FIG. 2, as viewed along the line 3-3 thereof.

FIGS. 4 and 5 are transverse sectional views of the surgical tool, asviewed along the lines 4-4 and 5-5 of FIGS. 2 and 3 respectively. FIG. 5showing the fluid distribution control.

FIG. 6 is a sectional view of the: surgical tool probe extending througha corneal opening, as seen along the line 6-6 of FIG. 1. r 1 l FIGS. 7through 10 are greatly enlarged perspective views of alternative probetips for the tool of F IG. 1.

FIG. 11 is a greatly enlarged perspective view of a surgical toolembodiment wherein the probe rod extends through afluid communicatingtube.

FIGS. 12, 13 and Marc fragmentary perspective views, partly in section,of surgical tool embodiments incorporating respectively a fiber opticlight guide, a freezing tip and a forceps.

DESCRIPTION OF THE PREFERRED EMBODIMENTS .T he following detaileddescription is of the bestpresently contemplated modes of carrying outthe invention. This description is not to be taken in a limiting sense,but is made merely for the purpose of illustrating the generalprinciples of the invention since the scope of the invention best isdefined by the appended claims.

Referring now to the drawings, the surgical tool 15 includes a generallycylindrical handle 16 having a conical end 17. Projecting from the end17 is a probe 18 which, in the embodiment of FIGS. .1 through 6,includes a rod 19 having a generally globular surgical tip 20, and apair of fluid communicating tubes 21, 22. Contained within the handle 16is a mechanism 23, described below, for imparting an arcuate or swingingmotion to the rod 19 and tip 20 in a plane (see the arrows 24 in FIGS. 2and 6) not including the tubes 21,

22. The extent of arcuate motion is limited, as by an adjustable stop26. Each stationary tube 21, 22 may deliver fluid from a supply 27 ormay suction fluid from the region of the tip 20 in cooperation with apump 28. A distributor 29 on the handle 16 controls such fluid deliveryand suction.

For eye surgery the rod 19 may have a length of about 18 millimeter andadiameter of about 0.5 millimeters. The surgical tip 20 may beelipsoidal or spherical with a maximum dimension of about 1 millimeter.In the embodiment of FIG. 7, useful for cutting the anterior lenscapsule, the tip 20a is generally elipsoidal and has a pointed or knifeedged projection 30 extending laterally about 0.1 millimeters. Theglobular tip 20b may have an abrasive surface with no cutting projection(FIG. 8) or a lateral cutting projection 30 may be combined with anabrasive surface as in the tip 200 of FIG. 9. In FIG. 10, a generallycrescent shaped cutting projection 31 extends from the forward end ofthe surgical tip 20d. The rod 19 may be situated within a fluid flowtube 21 (FIG. 11) having a diameter sufficient for the rod 19 to swingthrough a desired arc.

Use of the surgical tool 15 for cataract removal is illustrated inFIG. 1. Initially a small limbal opening 35 (typically less than 3millimeters diameter) is made in the eye 36 where the cornea 37 joinsthe sclera 38. The probe 18 is inserted through the opening 35 in aplane generally parallel to the iris 39. The mechanism 23 is energizedto swing the probe 19 back and forth through an arc of less than about 3millimeters, preferably at a selected rate of from to about 100 cyclesper second.

Using the surgical tip 20a (FIG. 7), multiple small incisions are madein the anterior capsule 40 of the lens 41. Alternatively, the roughenedtip 20b or 20c may be used to macerate the capsule 40. The distributor29 is adjusted to suction fluid from the region of the tip 20 via one ofthe tubes 21, 22 and to supply an appropriate sterile isotonic fluid tothe same region via the other tube 21, 22. As small particles of thecapsule 40 material are cut away or macerate, they are suctioned oraspirated from the eye 36 via the tool 15. The supplied fluid replacesthat removed, insuring a substantially constant pressure within theanterior chamber 42 to prevent collapse of the cornea 37.

With part of the capsule 40 cut away, the probe 18 is inserted withinthe lens and used to break up and remove occluded cortex 41 and/ornucleus 41a material. The tool then may be used to cut and remove theposterior lens capsule 43. Particles, if any, too large to be suctionedthrough the tube 21 or 22 may escape or be withdrawn through the opening35. If a different surgical tip is desired, the probe 18 may be removedfrom the eye 36, a new tip substituted, and the instrument reinserted tocontinue the operation. When all lens material has been removed, theprobe 18 is withdrawn and a single suture used to close the opening 35.

An entire senile cataract can be removed with the surgical tool 15 inless than about 15 minutes. There is little trauma and a very shortrecovery period.

The surgical tool 15 is useful for other types of eye surgery. Thus aniridotomy may be perfonned using any of the surgical tips 20a, 20b, 206or 20d to form small holes in the iris 39. The iridotomy may be combinedwith a cataract procedure making a separate iridectomy unnecessary.Using the surgical tool 15 for iridencleisis, the probe l8 is used tomake small openings through the sclera 38 from inside the iris angle(trabecular meshwork) to permit material of the iris 39 to escape. Suchprocedures are useful to drain or relieve ex- 'cess internal pressure inthe treatment of congenital or acquired glaucoma. The tool 15 may beused for vitreous surgery and for treatment of flat chambers. Since thetips 20a 20d are dull and rounded, the chance of inadvertent damage toeye tissue is minimal.

Other forms of the probe 18 increase the versatility of the surgicaltool 15. For example (FIG. 11) a fiber optic light guide 44 may be usedto illuminate the operative area at the surgical tip 20. A freezingprobe 45 (FIG. 13) may be incorporated either instead of or in additionto the rod 19. Such a freezing probe 45 may comprise a metal rod 46having an insulative sheathing 47 and communicating between a freezingtip 48 and a reservoir 49 containing freon or other liquid at anappropriate cryogenic temperature. The probe 45 is useful for freezingtumors or cysts. Tumors of the iris 39 or ciliary body 51 (FIG. 1) maybe reached interiorly of the eye 36, via the anterior chamber 42 or theposterior chamber 52, to be frozen bythe tip 48. The freezing tip 48 ora heating tip (not shown) may be used to affect the ciliary bodyproduction of aqueous in the treatment or control of glaucoma by directapplication from inside the anterior chamber 42.

Alternatively, the freezing tip 48 or heating tip may be used tocauterize blood vessels, as in the zonular region 53. A forceps tip 55(FIG. 14) is useful for removing sections of eye tissue too large to beaspirated via the tube 21 or 22. 9

Details of the fluid distributor control 29 are shown in FIGS. 2 and 5.The tubes 21, 22 extend through the handle 16 to terminations 21a, 22aopening into the distributor 29. The fluid supply 27 and the pump 28respectively are connected to the handle 16 via a pair of flexible tubes56, 57 leading to distributor openings 56a, 57a. The distributor control29 is rotatable relative to the handle 16 and has five sets of channelsfor selectively connecting the tubes 21, 22 to the tubes 56, 57.

With the distributor 29 set to the position 29a (FIG. 5), the tube .21communicates via the termination 21a, the channel 58 and the opening 56ato the supply tube 56. Similarly, the tube 22 is connected via thedistributor channel 59 to the suction tube 57. Accordingly,

fluid from the supply 27 is supplied to the region of the tip 18 via thetube 21, and fluid is suctioned via the tube 22 to the pump 28.

In the position 29b, the distributor 29 interchanges the supply andsuction lines so that fluid is supplied via the tube 22 and pumped viathe tube 21. In the positions 29c, 29d and 29e the pump 29 is connectedto neither tube 21, 22 so that no suctioning takes place. However, fluidis delivered respectively via the tube 21, the tube 22, or both tubes 21and 22. An appropriate detent 60 maintains the distributor control 29 atthe selected position.

In the embodiment ofFlGS. 2 through 4, a simple electromagnetic vibrator23 imparts swinging motion to the rod 19. Thus the mechanism 23 includesan electromagnet 61 mounted within the handle 16 by a support 62ofplastic or like insulating material. One leg 63a of a generallyLl-shaped flat metal strip 63 also is mounted to the support 62. Theother leg 63!) is spaced from the pole pieces 61a so as to be attractedby the electromagnet 61. The free end 63c of the strip 63 is situatedalong the longitudinal axis .of the handle 16 and terminates at afitting 64 which releasably retains the rod 19. The strip section 630extends between the are limiting stops 26.

. The electromagnet 35 is energized by a signal from a power supply 65supplied via a cable 66. The signal may comprise voltage pulses suppliedat a rate adjusted by a control 67 in the handle 16. Eachpulse-energizes the magnet 61 so as to attract the metal section 63b andcause the rod 19 to move upward as viewed in FIG. 2. When the pulseterminates, the magnet 61 is deenergized and the resiliency of themember 63 causes the section 63b to swing away from the pole pieces 61a,carrying the rod 19 downward (FIG. 2). The stops 26 limit the extent ofarcuate travel of the tip 20. Typically, the pulse rate may be selectedso that the rod 19 swings back and forth at a rate in the range of from0 to about 100 cycles per second.

An electrical contact (not shown) may be provided in circuit with themagnet 61 to be opened and closed as the member'63b vibrates. The member63b thus may interrupt a dc voltage supplied via the line 66 to themagnet 61. The magnitude of the voltage could be ad justed by thecontrol 67to affect the swing rate of the rod 19. In other embodiments(not shown), the mechanism 23 might be replaced by a spring woundvibrator, by a small motor powered by batteries within the handle 16itself, or by other well known devices for imparting arcuate motion.

The member 62 may slide longitudinally within a slot 68 (FIG. 2) in thehandle 16. Since the member 62 carries the strip 63, longitudinalmovement of the'member 62 will adjust the position of the leg 630relative to the stops 26, and thereby control the arc of the rod 19.Alternatively, the stops 26 may be positionable separately by means of afinger control member 69. The tubes 21, 22 might be coiled around themechanism 23 so that the fluid flowing through the tubes will cool themechanism. Foot controls (not shown) may be provided to control the rod19 swing rate and/or adjust the fluid flow and suction rates through thestationary tubes 21 v and 22.

.The tool is by no means limited to use in eye surgery, but is equallyuseful in other applications where tissue is to be sectioned, incised,frozen or cauterized in any accessible body cavity or subcutaneouslocation.

The tool 15 is useful for biopsies and eviscerations, and

6 tions, the probe dimensionsmay differ from those described above forophthalmological surgery.

Intending to claim all novel, useful and unobvious features shown ordescribed, I make the following claims:

1. A surgical tool for prising:

an elongated tubular handpiece,

a probe extending from one end of said handpiece, said probe having aglobular surgical tip with a maximum diameter of less than about l.5millime- ICXS,

means mounted in said handpiece for imparting only swinging motion tosaid probe through a limited arc in one plane only, at a rate ofswinging of less than about cycles per second, and

at least one fluid flow tube extending from said handpiece endgenernally parallel to said probe but spaced from said plane forcommunicating fluid to or from the region of said tip.

2. A surgical tool according to claim 1 wherein said surgical tipincludes a lateral cutting projection which protrudes less than about0.2 millimeter.

3. A surgical tool according to claim 1 wherein said globular tipincludes a forward cutting projection which protrudes less than about0.2 millimeter.

4. A surgical tool according to claim 1 wherein said probe extends fromsaid handpiece less than about 25 millimeters, wherein said probediameter is less than about 1 millimeter, wherein said tube is less thanabout 2 millimeters in diametenand wherein said are is limited to amaximum tip excursion of less than about 3 millimeters.

5. A surgical tool according to claim 4 further comprising means, insaid handpiece, for selectively adjusting the limits of said arc.

opthalmological surgery com- 6.. A surgical tool according to claim 1and having two fluid flow tubes extending from said handpiece, togetherwithmeans 'for selectively supplying fluid via one or both or said tubesand means for suctioning fluid from the region of said tip via one ofsaid tubes.

'7. A surgical tool according to claim 6 together with control means forselectively interconnecting said tubes and said means for supplying andsuctioning.

8. A surgical tool according to claim 1 wherein said tube surrounds saidprobe and is of sufficient diameter to permit said probe to swingthrough said limited are within said surrounding tube.

9. A surgical tool according to claim 1 wherein said probe is detachablefrom said means for imparting said swinging motion.

10. A surgical tool according to claim 1 together with fiber optic meansfor guiding light to the region of said tip.

11. A surgical tool according to claim 1 wherein said means forimparting said swinging motion comprises:

a lever arm extending through a portion of said,

handpiece and electromagnetic means for periodically attracting said armtoward one side of said handpiece, said arm thereafter resilientlyreturning toward the.

other side of said handpiece, such action imparting said swinging motionto said probe. 12. A hand held tool for opthalmological surgerycomprising:

a handpiece,

probe means extending from an end of said handpiece and consisting of aprobe having a surgical tip,

means mounted in said handpiece for swinging said probe through alimited are at a rate less than about 100 cycles per second, the probebeing prevented from longitudinal motion in a direction parallel to thehandpiece, the surgical tip of said probe being globular and having amaximum diameter of less than about 1.5 millimeters, said probeextending from said handpiece less than about 25 millimeters and havinga diameter less than about 1 millimeter, said are being limited to amaximum tip excursion of less than about 3 millimeters, and

means, in said handpiece, for selectively adjusting the limits of saidarc.

13. A surgical tool according to claim 12 further comprising:

a pair of tubes extending from said handpiece generally parallel to saidprobe, together with means for supplying fluid, means for suctioningfluid, and distributor control means in said handpiece for selectivelyinterconnecting said tubes and said means for supplying and suctioning.

14. A surgical tool according to claim 12 further comprising a lightguide extending beside said probe from said handpiece to the vicinity ofsaid surgical tip.

15. A surgical tool according to claim 12 wherein said surgical tip isglobular and includes a lateral cutting projection.

16. A surgical tool according to claim 12 wherein said surgical tip isglobular, at least a portion of the surface of said globular surgicaltip being abrasive.

17. A surgical tool according to claim 12 wherein said surgical tip isglobular and includes a forward cutting projection.

18. A surgical tool according to claim 1 wherein said globular surgicaltip includes an abrasive surface region.

1. A surgical tool for opthalmological surgery comprising: an elongatedtubular handpiece, a probe extending from one end of said handpiece,said probe having a globular surgical tip with a maximum diameter ofless than about 1.5 millimeters, means mounted in said handpiece forimparting only swinging motion to said probe through a limited arc inone plane only, at a rate of swinging of less than about 100 cycles persecond, and at least one fluid flow tube extending from said handpieceend genernally parallel to said probe but spaced from said plane forcommunicating fluid to or from the region of said tip.
 2. A surgicaltool according to claim 1 wherein said surgical tip includes a lateralcutting projection which protrudes less than about 0.2 millimeter.
 3. Asurgical tool according to claim 1 wherein said globular tip includes aforward cutting projection which protrudes less than about 0.2millimeter.
 4. A surgical tool according to claim 1 wherein said probeextends from said handpiece less than about 25 millimeters, wherein saidprobe diameter is less than about 1 millimeter, wherein said tube isless than about 2 millimeters in diameter, and wherein said arc islimited to a maximum tip excursion of less than about 3 millimeters. 5.A surgical tool according to claim 4 further comprisIng means, in saidhandpiece, for selectively adjusting the limits of said arc.
 6. Asurgical tool according to claim 1 and having two fluid flow tubesextending from said handpiece, together with means for selectivelysupplying fluid via one or both or said tubes and means for suctioningfluid from the region of said tip via one of said tubes.
 7. A surgicaltool according to claim 6 together with control means for selectivelyinterconnecting said tubes and said means for supplying and suctioning.8. A surgical tool according to claim 1 wherein said tube surrounds saidprobe and is of sufficient diameter to permit said probe to swingthrough said limited arc within said surrounding tube.
 9. A surgicaltool according to claim 1 wherein said probe is detachable from saidmeans for imparting said swinging motion.
 10. A surgical tool accordingto claim 1 together with fiber optic means for guiding light to theregion of said tip.
 11. A surgical tool according to claim 1 whereinsaid means for imparting said swinging motion comprises: a lever armextending through a portion of said, handpiece and electromagnetic meansfor periodically attracting said arm toward one side of said handpiece,said arm thereafter resiliently returning toward the other side of saidhandpiece, such action imparting said swinging motion to said probe. 12.A hand held tool for opthalmological surgery comprising: a handpiece,probe means extending from an end of said handpiece and consisting of aprobe having a surgical tip, means mounted in said handpiece forswinging said probe through a limited arc at a rate less than about 100cycles per second, the probe being prevented from longitudinal motion ina direction parallel to the handpiece, the surgical tip of said probebeing globular and having a maximum diameter of less than about 1.5millimeters, said probe extending from said handpiece less than about 25millimeters and having a diameter less than about 1 millimeter, said arcbeing limited to a maximum tip excursion of less than about 3millimeters, and means, in said handpiece, for selectively adjusting thelimits of said arc.
 13. A surgical tool according to claim 12 furthercomprising: a pair of tubes extending from said handpiece generallyparallel to said probe, together with means for supplying fluid, meansfor suctioning fluid, and distributor control means in said handpiecefor selectively interconnecting said tubes and said means for supplyingand suctioning.
 14. A surgical tool according to claim 12 furthercomprising a light guide extending beside said probe from said handpieceto the vicinity of said surgical tip.
 15. A surgical tool according toclaim 12 wherein said surgical tip is globular and includes a lateralcutting projection.
 16. A surgical tool according to claim 12 whereinsaid surgical tip is globular, at least a portion of the surface of saidglobular surgical tip being abrasive.
 17. A surgical tool according toclaim 12 wherein said surgical tip is globular and includes a forwardcutting projection.
 18. A surgical tool according to claim 1 whereinsaid globular surgical tip includes an abrasive surface region.